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Braxton ME, Woodward AL, Larson KL. Classes of medications prescribed to malnourished children and their relationship with time to recovery. Public Health Nurs 2024; 41:90-100. [PMID: 37897086 DOI: 10.1111/phn.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE There is conflicting evidence around prescription practices in the management of malnutrition; the study objective was to explore medication classifications prescribed and their relationship between time-to-recovery and specific demographic characteristics among children with malnutrition in Guatemala. DESIGN Descriptive correlational study of data obtained in a retrospective record review. SAMPLE Children aged 0-5 years with malnutrition treated in a Guatemalan Nutrition Rehabilitation Center between 2019 and 2020 (N = 155). MEASURES Variables assessed were medication classification of prescribed medications, age, gender, time-to-recovery, malnutrition severity, and COVID cohort. RESULTS The most frequently used medication classifications were vitamins (95%), respiratory (75%), antipyretic (68%), antibiotic (61%), and gastrointestinal agents (54%). Antibiotic, respiratory, corticosteroid, antipyretic, and gastrointestinal agents were prescribed significantly more in cases with a time-to-recovery of 6 weeks or greater. CONCLUSIONS Medication classifications prescribed most often were related to common comorbidities of malnutrition and illnesses affecting children in Guatemala, such as respiratory and diarrheal diseases. The medication used in cases with a time-to-recovery of ≥6 weeks suggest these cases may have had more comorbidities, which could explain the longer recovery times. Caution is suggested in routine prophylactic antibiotic use in public health settings, given the lack of association with improved recovery times, the potential for antibiotic drug resistance, and the negative effects on renal function among children.
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Affiliation(s)
- Morgan E Braxton
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Alexia L Woodward
- College of Nursing, East Carolina University, Greenville, North Carolina
| | - Kim L Larson
- College of Nursing, East Carolina University, Greenville, North Carolina
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2
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Toh JY, Cai S, Lim SX, Pang WW, Godfrey KM, Shek LP, Tan KH, Yap F, Lee YS, Chong YS, Eriksson JG, Broekman BFP, Rifkin-Graboi A, Chong MFF. Nutrient trajectories during infancy and their associations with childhood neurodevelopment. Eur J Nutr 2023; 62:2429-2439. [PMID: 37118033 DOI: 10.1007/s00394-023-03164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To examine the associations between infants' dietary nutrient trajectories and subsequent neurodevelopment during childhood in the Growing Up in Singapore Towards healthy Outcomes study. METHODS One-day food records were collected at ages 6, 9 and 12 months, whilst Bayley Scales of Infant and Toddler Development-III and Kaufman Brief Intelligence Test-2 were conducted at ages 24 and 54 months respectively. Nutrient trajectories were constructed using multi-level mixed modelling and associations with neurodevelopment (24 months: n = 484; 54 months: n = 444) were examined using adjusted multivariable linear regression. RESULTS At age 24 months, higher protein intake (at 6 months) and increasing rate of intake (from 6 to 12 months) were associated with higher fine motor score [β = 0.17 SD (95% CI 0.03, 0.31) and 0.62 SD (0.10, 1.14) respectively]. Higher fat intake was associated with higher receptive language score [0.04 SD (0.003, 0.07)], but increasing rate of intake was associated with lower expressive language [- 0.20 SD (- 0.39, - 0.01)] and fine motor [- 0.29 SD (- 0.48, - 0.10)] scores. Higher carbohydrate intake was associated with lower gross motor score [- 0.07 SD (- 0.14, - 0.005)], but increasing rate of intake was associated with higher receptive language [0.44 SD (0.08, 0.81)] and fine motor [0.56 SD (0.18, 0.93)] scores. Increasing rate of dietary fibre intake was associated with higher fine motor scores [0.63 SD (0.16, 1.10)]. No significant associations were observed with neurodevelopment at 54 months. CONCLUSION Our findings provide greater understanding of how nutrition over time could have varying effects on child neurodevelopment.
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Affiliation(s)
- Jia Ying Toh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Shirong Cai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shan Xuan Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Wei Wei Pang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Centre and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital, Southampton National Health Service Foundation Trust, Southampton, UK
| | - Lynette P Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Fabian Yap
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
- Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Birit F P Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Psychiatry, OLVG and Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Anne Rifkin-Graboi
- Centre for Research in Child Development, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
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3
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Picbougoum TB, Somda MAS, Zango SH, Lohmann J, De Allegri M, Saidou H, Hien H, Meda N, Robert A. Nutritional status of children under five years and associated factors in 24 districts of Burkina Faso. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001248. [PMID: 37523345 PMCID: PMC10389710 DOI: 10.1371/journal.pgph.0001248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 07/04/2023] [Indexed: 08/02/2023]
Abstract
Malnutrition in children is a serious health problem, especially in Sub-Saharan Africa, with heavy socioeconomic burdens. The prevalence of stunting remains high in Burkina Faso. There is a need to further investigate undernutrition and identify the major factors contributing to its persistence. We aimed to assess the nutritional status of children aged under five years and the associated factors of undernutrition in Burkina Faso. We conducted a second study using a baseline household survey of the impact assessment of a performance-based financing program. The analysis focused on data of 10,032 children aged 0-59 months collected from households in 537 villages. Anthropometric indicators were assessed using the World Health Organization standards, and their association with children, mothers, and households' characteristics were assessed using logistic regression. Stunting occurred in 40.1% of children, wasting in 25.1%, and underweight in 34%. Children having both stunting, wasting, and underweight were 7.3%. Stunting and underweight was associated with the sex. Stunting was associated with ethnic groups: Fulani with AdjOR = 1.20 (95%CI: 1.01-1.42), household economic level: poorest AdjOR = 1.25 (95%CI: 1.10-1.43), two and more children aged under five years in households: AdjOR = 1.16 (95%CI: 1.05-1.27), distance more than 5km from household to health facility: with Adj OR = 1.21 (95%CI: 1.10-1.35) and household food insecurity. This study identified the modifiable factors that determine the high prevalence of undernutrition in Burkina Faso. Strategies and interventions to improve the health and economic status of the community are needed to reduce the occurrence of undernutrition.
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Affiliation(s)
- T Bernadette Picbougoum
- Institut National de Santé Publique (INSP)/ Centre MURAZ, Bobo-Dioulasso, Burkina Faso
- Institut de Recherche Expérimentale et Clinique, Pôle Epidémiologie et Biostatistique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - M A Serge Somda
- Institut National de Santé Publique (INSP)/ Centre MURAZ, Bobo-Dioulasso, Burkina Faso
- Université Nazi Boni, Unité de Formation et de Recherche/Sciences et Technique, Bobo-Dioulasso, Burkina Faso
| | - S Henri Zango
- Institut National de Santé Publique (INSP)/ Centre MURAZ, Bobo-Dioulasso, Burkina Faso
- Institut de Recherche Expérimentale et Clinique, Pôle Epidémiologie et Biostatistique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale du Centre-Ouest, Nanoro, Burkina Faso
| | - Julia Lohmann
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | | | - Hervé Hien
- Institut National de Santé Publique (INSP)/ Centre MURAZ, Bobo-Dioulasso, Burkina Faso
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Nicolas Meda
- Université Joseph Ki-Zerbo, UFR/SDS, Ouagadougou, Burkina Faso
| | - Annie Robert
- Institut de Recherche Expérimentale et Clinique, Pôle Epidémiologie et Biostatistique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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Mbabazi J, Pesu H, Mutumba R, McCray G, Michaelsen KF, Ritz C, Filteau S, Briend A, Mupere E, Grenov B, Friis H, Olsen MF. Effect of Milk Protein and Whey Permeate in Large-Quantity Lipid-Based Nutrient Supplement on Early Child Development among Children with Stunting: A Randomized 2 × 2 Factorial Trial in Uganda. Nutrients 2023; 15:2659. [PMID: 37375563 DOI: 10.3390/nu15122659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Stunting affects 22% children globally, putting them at risk of adverse outcomes including delayed development. We investigated the effect of milk protein (MP) vs. soy and whey permeate (WP) vs. maltodextrin in large-quantity, lipid-based nutrient supplement (LNS), and LNS itself vs. no supplementation, on child development and head circumference among stunted children aged 1-5 years. We conducted a randomized, double-blind, community-based 2 × 2 factorial trial in Uganda (ISRCTN1309319). We randomized 600 children to one of four LNS formulations (~535 kcal/d), with or without MP (n = 299 vs. n = 301) or WP (n = 301 vs. n = 299), for 12 weeks or to no supplementation (n = 150). Child development was assessed using the Malawi Development Assessment Tool. Data were analyzed using linear mixed-effects models. Children had a median [interquartile range] age of 30 [23; 41] months and mean ± standard deviation height-for-age z-score of -3.02 ± 0.74. There were no interactions between MP and WP for any of the outcomes. There was no effect of either MP or WP on any developmental domain. Although LNS itself had no impact on development, it resulted in 0.07 (95%CI: 0.004; 0.14) cm higher head circumference. Neither dairy in LNS, nor LNS in itself, had an effect on development among already stunted children.
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Affiliation(s)
- Joseph Mbabazi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Department of Paediatrics and Child Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Hannah Pesu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Rolland Mutumba
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Department of Paediatrics and Child Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Gareth McCray
- School of Medicine, Keele University, Keele ST5 5BG, UK
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Christian Ritz
- The National Institute of Public Health, University of Southern Denmark, 5230 Odense, Denmark
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere University Hospital, 33520 Tampere, Finland
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Mette Frahm Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Department of Infectious Diseases, Rigshospitalet, 2100 Copenhagen, Denmark
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Cichon B, Das JK, Salam RA, Padhani ZA, Stobaugh HC, Mughal M, Pajak P, Rutishauser-Perera A, Bhutta ZA, Black RE. Effectiveness of Dietary Management for Moderate Wasting among Children > 6 Months of Age-A Systematic Review and Meta-Analysis Exploring Different Types, Quantities, and Durations. Nutrients 2023; 15:nu15051076. [PMID: 36904076 PMCID: PMC10005276 DOI: 10.3390/nu15051076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Currently, no World Health Organization guidelines exist for the management of approximately 31.8 million moderately wasted children globally. The objective of this review was to synthesise evidence on the optimal type, quantity, and duration of dietary treatment for moderate wasting. Ten electronic databases were searched until the 23rd of August 2021. Experimental studies comparing interventions for the dietary management of moderate wasting were included. Meta-analyses were conducted and results were presented as risk ratios or mean differences with 95% confidence intervals. Seventeen studies comparing specially formulated foods were included involving 23,005 participants. Findings suggest little or no difference in recovery between Fortified Blended Foods (FBFs) with improved micronutrient and/or milk content (enhanced FBFs) and lipid-based nutrient supplements (LNS), whereas children treated with non-enhanced FBFs (locally produced FBFs or standard corn-soy blend) may have lower recovery rates than those treated with LNS. There was no difference in recovery when ready-to-use therapeutic and ready-to-use supplementary food were compared. Other outcomes mostly aligned with results for recovery. In conclusion, LNSs improve recovery compared to non-enhanced FBFs, but are comparable to enhanced FBFs. Programmatic choice of supplement should consider factors such as cost, cost-effectiveness, and acceptability. Further research is required to determine optimal dosing and duration of supplementation.
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Affiliation(s)
- Bernardette Cichon
- Action Against Hunger UK, Operations Department, London SE10 0ER, UK
- Correspondence:
| | - Jai K. Das
- Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan
- Division of Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Rehana A. Salam
- The Daffodil Centre, The University of Sydney, Sydney 2006, Australia
| | - Zahra A. Padhani
- Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan
| | - Heather C. Stobaugh
- Action Against Hunger USA, Technical Services and Innovation Department, Washington, DC 20463, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Muzna Mughal
- Action Against Hunger UK, Operations Department, London SE10 0ER, UK
| | - Patrizia Pajak
- Action Against Hunger UK, Operations Department, London SE10 0ER, UK
| | | | - Zulfiqar A. Bhutta
- Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan
- Division of Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Robert E. Black
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Chebet M, Musaba MW, Mukunya D, Makoko B, Napyo A, Nantale R, Auma P, Atim K, Nahurira D, Lee S, Okello D, Ssegawa L, Bromley K, Burgoine K, Ndeezi G, Tumwine JK, Wandabwa J, Kiguli S. High Burden of Neurodevelopmental Delay among Children Born to Women with Obstructed Labour in Eastern Uganda: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3470. [PMID: 36834165 PMCID: PMC9963417 DOI: 10.3390/ijerph20043470] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 05/11/2023]
Abstract
Over 250 million infants in low and middle-income countries do not fulfill their neurodevelopment potential. In this study, we assessed the incidence and risk factors for neurodevelopmental delay (NDD) among children born following obstructed labor in Eastern Uganda. Between October 2021 and April 2022, we conducted a cohort study of 155 children (aged 25 to 44 months), born at term and assessed their neurodevelopment using the Malawi Developmental Assessment Tool. We assessed the gross motor, fine motor, language and social domains of neurodevelopment. The incidence of neurodevelopmental delay by 25 to 44 months was 67.7% (105/155) (95% CI: 59.8-75.0). Children belonging to the poorest wealth quintile had 83% higher risk of NDD compared to children belonging to the richest quintile (ARR (Adjusted Risk Ratio): 1.83; 95% CI (Confidence Interval): [1.13, 2.94]). Children fed the recommended meal diversity had 25% lower risk of neurodevelopmental delay compared to children who did not (ARR: 0.75; 95% CI: [0.60, 0.94]). Children who were exclusively breastfed for the first 6 months had 27% lower risk of neurodevelopmental delay compared to children who were not (ARR: 0.73; 95% CI: [0.56, 0.96]). We recommend that infants born following obstructed labor undergo neurodevelopmental delay screening.
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Affiliation(s)
- Martin Chebet
- Department of Pediatrics and Child Health, Busitema University, Mbale P.O. Box 1460, Uganda
- Department of Global Public Health and Primary Health Care, Centre for International Health, University of Bergen, 5007 Bergen, Norway
| | - Milton W. Musaba
- Department of Obstetrics and Gynecology, Busitema University, Mbale P.O. Box 1460, Uganda
| | - David Mukunya
- Department of Community and Public Health, Busitema University, Mbale P.O. Box 1460, Uganda
- Department of Research, Nikao Medical Center, Kampala P.O. Box 10005, Uganda
| | - Brian Makoko
- Department of Community and Public Health, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Agnes Napyo
- Department of Community and Public Health, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Proscovia Auma
- Department of Obstetrics and Gynecology, Mbale Regional Referral Hospital, Mbale P.O. Box 921, Uganda
| | - Ketty Atim
- Department of Obstetrics and Gynecology, Mbale Regional Referral Hospital, Mbale P.O. Box 921, Uganda
| | - Doreck Nahurira
- Department of Obstetrics and Gynecology, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Seungwon Lee
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dedan Okello
- Department of Pediatrics and Child Health, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Lawrence Ssegawa
- Department of Research, Sanyu Africa Research Institute, Mbale P.O. Box 2190, Uganda
| | - Kieran Bromley
- Research Institute for Primary Care and Health Sciences, School of Medicine, Keele University, Newcastle ST5 5BG, UK
| | - Kathy Burgoine
- Neonatal Unit, Mbale Regional Referral Hospital, Mbale P.O. Box 921, Uganda
| | - Grace Ndeezi
- Department of Pediatrics and Child Health, Makerere University, Kampala P.O. Box 7062, Uganda
| | - James K. Tumwine
- Department of Pediatrics and Child Health, Makerere University, Kampala P.O. Box 7062, Uganda
- Department of Pediatrics and Child Health, Kabale University, Kabale P.O. Box 317, Uganda
| | - Julius Wandabwa
- Department of Obstetrics and Gynecology, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Sarah Kiguli
- Department of Pediatrics and Child Health, Makerere University, Kampala P.O. Box 7062, Uganda
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Augustus E, Haynes E, Guell C, Morrissey K, Murphy MM, Halliday C, Jia L, Iese V, Anderson SG, Unwin N. The Impact of Nutrition-Based Interventions on Nutritional Status and Metabolic Health in Small Island Developing States: A Systematic Review and Narrative Synthesis. Nutrients 2022; 14:nu14173529. [PMID: 36079787 PMCID: PMC9460279 DOI: 10.3390/nu14173529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022] Open
Abstract
Small island developing states (SIDS) have a high burden of nutrition-related disease associated with nutrient-poor, energy-dense diets. In response to these issues, we assessed the effectiveness of nutrition-based interventions on nutritional status (under-nutrition) and metabolic health (over-nutrition) among persons in SIDS. We included SIDS-based nutrition studies with change in nutrition status (e.g., markers of anaemia) or metabolic status (e.g., markers of glycaemia) as outcomes. The PRISMA framework was applied and MEDLINE, Embase, CINAHL, OARE library, Web of Science, Scopus, ASSIA, EconLit, AGORA, AGRICOLA, AGRIS, WHO-EMRO, and LILACS were searched (2000−2020). Cochrane risk of bias (ROB) and Cochrane ROBINS-I tools assessed ROB for randomised and non-randomised studies, respectively. PROSPERO registration (CRD42021236396) was undertaken. We included 50 eligible interventions, involving 37,591 participants: 14 trials reported on nutritional status, 36 on metabolic health. Effective interventions, evaluated at the individual level, took a multifaceted approach for metabolic outcomes; while nutrition outcomes utilised supplements. Most intervention types were suitable for issues related to ‘over’ nutrition versus ‘under’ nutrition. Twenty-six studies (nutrition status (six); metabolic health (twenty)) were effective (p < 0.05). With the current rise of nutrition-related public health challenges, there is a need for further development and evaluation of these and related interventions at the population level.
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Affiliation(s)
- Eden Augustus
- The Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, P.O. Box 64, Bridgetown BB11000, Barbados
- Correspondence:
| | - Emily Haynes
- European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK
| | - Karyn Morrissey
- Division of Sustainability, Society and Economics, Department of Technology, Management and Economics, Technical University of Denmark, Produktionstorvet 358, DK-2800 Kgs. Lyngby, Denmark
| | - Madhuvanti M. Murphy
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute of Health Research, The University of the West Indies, Bridgetown BB11000, Barbados
| | - Cassandra Halliday
- European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK
| | - Lili Jia
- Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK
| | - Viliamu Iese
- Pacific Centre for Environment and Sustainable Development, University of the South Pacific, Suva 0101, Fiji
| | - Simon G. Anderson
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute of Health Research, The University of the West Indies, Bridgetown BB11000, Barbados
- Glasgow-Caribbean Centre for Development Research, University of the West Indies, Bridgetown BB11000, Barbados
| | - Nigel Unwin
- European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
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8
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Serum cobalamin in children with moderate acute malnutrition in Burkina Faso: Secondary analysis of a randomized trial. PLoS Med 2022; 19:e1003943. [PMID: 35263343 PMCID: PMC8906584 DOI: 10.1371/journal.pmed.1003943] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 02/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Among children with moderate acute malnutrition (MAM) the level of serum cobalamin (SC) and effect of food supplements are unknown. We aimed to assess prevalence and correlates of low SC in children with MAM, associations with hemoglobin and development, and effects of food supplements on SC. METHODS AND FINDINGS A randomized 2 × 2 × 3 factorial trial was conducted in Burkina Faso. Children aged 6 to 23 months with MAM received 500 kcal/d as lipid-based nutrient supplement (LNS) or corn-soy blend (CSB), containing dehulled soy (DS) or soy isolate (SI) and 0%, 20%, or 50% of total protein from milk for 3 months. Randomization resulted in baseline equivalence between intervention groups. Data on hemoglobin and development were available at baseline. SC was available at baseline and after 3 and 6 months. SC was available from 1,192 (74.1%) of 1,609 children at baseline. The mean (±SD) age was 12.6 (±5.0) months, and 54% were females. Low mid-upper arm circumference (MUAC; <125 mm) was found in 80.4% (958) of the children and low weight-for-length z-score (WLZ; <-2) in 70.6% (841). Stunting was seen in 38.2% (456). Only 5.9% were not breastfed. Median (IQR) SC was 188 (137; 259) pmol/L. Two-thirds had SC ≤222 pmol/L, which was associated with lower hemoglobin. After age and sex adjustments, very low SC (<112 pmol/L) was associated with 0.21 (95% CI: 0.01; 0.41, p = 0.04) and 0.24 (95% CI: 0.06; 0.42, p = 0.01) z-score lower fine and gross motor development, respectively. SC data were available from 1,330 (85.9%) of 1,548 children followed up after 3 months and 398 (26.5%) of the 1,503 children after 6 months. Based on tobit regression, accounting for left censored data, and adjustments for correlates of missing data, the mean (95% CI) increments in SC from baseline to the 3- and 6-month follow-up were 72 (65; 79, p < 0.001) and 26 (16; 37, p < 0.001) pmol/L, respectively. The changes were similar among the 310 children with SC data at all 3 time points. Yet, the increase was 39 (20; 57, p < 0.001) pmol/L larger in children given LNS compared to CSB if based on SI (interaction, p < 0.001). No effect of milk was found. Four children died, and no child developed an allergic reaction to supplements. The main limitation of this study was that only SC was available as a marker of status and was missing from a quarter of the children. CONCLUSIONS Low SC is prevalent among children with MAM and may contribute to impaired erythropoiesis and child development. The SC increase during supplementation was inadequate. The bioavailability and adequacy of cobalamin in food supplements should be reconsidered. TRIAL REGISTRATION ISRCTN Registry ISRCTN42569496.
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Stephenson K, Callaghan-Gillespie M, Maleta K, Nkhoma M, George M, Park HG, Lee R, Humphries-Cuff I, Lacombe RJS, Wegner DR, Canfield RL, Brenna JT, Manary MJ. Low linoleic acid foods with added DHA given to Malawian children with severe acute malnutrition improve cognition: a randomized, triple-blinded, controlled clinical trial. Am J Clin Nutr 2021; 115:1322-1333. [PMID: 34726694 PMCID: PMC9071416 DOI: 10.1093/ajcn/nqab363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/28/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is concern that the PUFA composition of ready-to-use therapeutic food (RUTF) for the treatment of severe acute malnutrition (SAM) is suboptimal for neurocognitive recovery. OBJECTIVES We tested the hypothesis that RUTF made with reduced amounts of linoleic acid, achieved using high-oleic (HO) peanuts without added DHA (HO-RUTF) or with added DHA (DHA-HO-RUTF), improves cognition when compared with standard RUTF (S-RUTF). METHODS A triple-blind, randomized, controlled clinical feeding trial was conducted among children with uncomplicated SAM in Malawi with 3 types of RUTF: DHA-HO-RUTF, HO-RUTF, and S-RUTF. The primary outcomes, measured in a subset of subjects, were the Malawi Developmental Assessment Tool (MDAT) global z-score and a modified Willatts problem-solving assessment (PSA) intention score for 3 standardized problems, measured 6 mo and immediately after completing RUTF therapy, respectively. MDAT domain z-scores, plasma fatty acid content, anthropometry, and eye tracking were secondary outcomes. Comparisons were made between the novel PUFA RUTFs and S-RUTF. RESULTS Among the 2565 SAM children enrolled, mean global MDAT z-scores were -0.69 ± 1.19 and -0.88 ± 1.27 for children receiving DHA-HO-RUTF and S-RUTF, respectively (difference 0.19, 95% CI: 0.01, 0.38). Children receiving DHA-HO-RUTF had higher gross motor and social domain z-scores than those receiving S-RUTF. The PSA problem 3 scores did not differ by dietary group (OR: 0.92, 95% CI: 0.67, 1.26 for DHA-HO-RUTF). After 4 wk of treatment, plasma phospholipid EPA and α-linolenic acid were greater in children consuming DHA-HO-RUTF or HO-RUTF when compared with S-RUTF (for all 4 comparisons P values < 0.001), but only plasma DHA was greater in DHA-HO-RUTF than S-RUTF (P < 0.001). CONCLUSIONS Treatment of uncomplicated SAM with DHA-HO-RUTF resulted in an improved MDAT score, conferring a cognitive benefit 6 mo after completing diet therapy. This treatment should be explored in operational settings. This trial was registered at clinicaltrials.gov as NCT03094247.
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Affiliation(s)
- Kevin Stephenson
- Department of Medicine, Washington University, St.
Louis, MO, USA
| | | | - Kenneth Maleta
- Department of Public Health, School of Public Health & Family Medicine,
Kamuzu University of Health Sciences, Blantyre,
Malawi
| | - Minyanga Nkhoma
- Department of Public Health, School of Public Health & Family Medicine,
Kamuzu University of Health Sciences, Blantyre,
Malawi
| | - Matthews George
- Department of Public Health, School of Public Health & Family Medicine,
Kamuzu University of Health Sciences, Blantyre,
Malawi
| | - Hui Gyu Park
- Department of Pediatrics, University of Texas at Austin,
Austin, TX, USA
| | - Reginald Lee
- Department of Pediatrics, Washington University,
St. Louis, MO, USA
| | | | - R J Scott Lacombe
- Department of Pediatrics, University of Texas at Austin,
Austin, TX, USA
| | - Donna R Wegner
- Department of Pediatrics, Washington University,
St. Louis, MO, USA
| | - Richard L Canfield
- Department of Pediatrics, University of Texas at Austin,
Austin, TX, USA
| | - J Thomas Brenna
- Department of Pediatrics, University of Texas at Austin,
Austin, TX, USA,Division of Nutritional Sciences, Cornell University,
Ithaca, NY, USA
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10
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Pesu H, Mutumba R, Mbabazi J, Olsen MF, Mølgaard C, Michaelsen KF, Ritz C, Filteau S, Briend A, Mupere E, Friis H, Grenov B. The Role of Milk Protein and Whey Permeate in Lipid-based Nutrient Supplements on the Growth and Development of Stunted Children in Uganda: A Randomized Trial Protocol (MAGNUS). Curr Dev Nutr 2021; 5:nzab067. [PMID: 34027295 PMCID: PMC8128719 DOI: 10.1093/cdn/nzab067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/25/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Stunting is associated with cognitive impairment and later chronic disease. Previous trials to prevent stunting have had little effect, and no trials seem to have provided larger amounts of energy and high-quality proteins to already stunted children. We aimed to assess the effects of milk protein (MP) and whey permeate (WP) in large-quantity lipid-based nutrient supplements (LNS-LQ), among stunted children, on linear growth and child development. This was a randomized, double-blind, 2-by-2 factorial trial. Stunted children aged 12-59 mo from eastern Uganda (n = 750) were randomly assigned to receive 100 g LNS-LQ with or without MP and WP (n = 4 × 150) or no supplement (n = 150) for 3 mo. The primary outcomes were change in knee-heel and total length. Secondary outcomes included child development, body composition, anthropometry, and hemoglobin. Micronutrient status, intestinal function, and microbiota were also assessed. Our findings will contribute to an understanding of the role of milk ingredients and LNS in linear catch-up growth. This trial was registered at www.isrctn.com as ISRCTN13093195.
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Affiliation(s)
- Hannah Pesu
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Rolland Mutumba
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Mbabazi
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mette F Olsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Suzanne Filteau
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - André Briend
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
- Tampere Centre for Child Health Research, Tampere University, Tampere, Finland
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Benedikte Grenov
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
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